Google Glass could become the future in surgery

Anahad O'Connor

Before scrubbing in on a recent Tuesday morning, Selene Parekh, an orthopaedic surgeon at Duke Medical Centre, slipped on a pair of sleek, black glasses – Google Glass, the wearable computer with a built-in camera and monitor. He gave the internet-connected glasses a voice command to start recording and turned to the middle-aged motorcycle crash victim on the operating table.

He chiselled through bone, repaired a broken metatarsal and drilled a metal plate into the patient’s foot.

Changes: Surgeons in the US are turning to Google Glass to stream operations online as a learning tool.

Dr Parekh has been using Glass since last year, when Google began selling test versions of its device to thousands of hand-picked "explorers" for US$1500 ($1620). He uses it to record and archive all of his surgeries at Duke, and soon he will use it to stream live feeds of his operations to hospitals in India as a way to train and educate orthopaedic surgeons there.

"In India, foot and ankle surgery is about 40 years behind where we are in the US," he said. "So to be able to use Glass to broadcast this and have orthopaedic surgeons around the world watch and learn from expert surgeons in the US would be tremendous."

At Duke and other hospitals, a growing number of surgeons are using Google Glass to stream their operations online, float medical images in their field of view and hold video consultations with colleagues as they operate.

Software developers, too, have created programs that transform the Glass projector into a medical dashboard that displays patient vital signs, urgent lab results and surgical checklists.

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"I’m sure we’re going to use this in medicine," said Oliver J. Muensterer, a paediatric surgeon who recently published the first peer-reviewed study on the use of Glass in clinical medicine. "Not the current version, but a version in the future that is specially made for healthcare with all the privacy, hardware and software issues worked out."

For his study, published in the International Journal of Surgery, Dr Muensterer wore the device daily for four weeks at Maria Fareri Children’s Hospital at Westchester Medical Centre in New York. He found that filming rapidly drains the battery and that the camera – which is mounted straight ahead – does not point directly at what he is looking at when he is hunched over a patient with his eyes tilted downward.

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He also had to keep the device disconnected from the internet most of the time to prevent patient data and images from being automatically uploaded to the cloud. "Once it’s on the cloud, you don’t know who has access to it," Dr Muensterer said.

Google has yet to announce a release date for Glass, and the company declined to comment on how many of its testers were doctors or affiliated with hospitals. But "demand is high," Nate Gross, a co-founder of Rock Health, a medical technology incubator, said. "I probably get asked every few days by another doctor who wants to somehow incorporate Glass into their practice."

Already, outside hospitals, privacy concerns have led some bars and restaurants to ban the devices. Legislators have proposed restrictions on the use of Google Glass while driving, citing concerns about distraction. Doctors, too, are raising similar concerns.

The Glass projector is slightly above the user’s right eye, allowing doctors to see medical information without turning away from patients. But the display can also be used to see email and surf the web, potentially allowing doctors to take multitasking to dangerous new levels, Peter J. Papadakos at the University of Rochester Medical Centre said.

"Being able to see your laparoscopic images when you’re operating face to face instead of looking across the room at a projection screen is just mind-bogglingly fantastic," Dr Papadakos, who has published articles on electronic distractions in medicine, said. "But the downside is you don’t want that same surgeon interacting with social media while he’s operating."

Indeed, similar technology has not always had the smoothest results. Studies have found, for example, that navigational displays can help surgeons find tumours, but they can also induce a form of tunnel vision, or perceptual blindness, that makes them more likely to miss unrelated lesions or problems in surrounding tissue.

In aviation, Caroline G.L. Cao, who studies image-guided surgery at Wright State University, said pilots who wear head-mounted displays that show crucial flight information can lose sight of what is happening outside their windshields.

"Pilots can get so focused on aligning the icons that help them land the plane," Dr Cao said, "that they miss another plane that is crossing the runway."

One doctor who does not allow the device in his practice, Matthew S. Katz, the medical director of radiation oncology at Lowell General Hospital in Massachusetts, said that security and distractions were primary concerns.

A doctor wearing Glass could accidentally stream confidential medical information online, and patients might not feel comfortable with their doctors’ wearing cameras on their faces.

Dr Katz, who is also an outsider adviser for the Mayo Clinic Centre for Social Media, said until Glass has been better studied in healthcare and equipped with safeguards, doctors should be forced to check their wearable computers at the clinic door.

"From an ethical standpoint, the bar is higher for use in a medical setting," he said. "As a doctor, I have to make sure that what I’m doing is safe and secure for my patients – 'First, do no harm'. Until I am, I don’t want it in my practice."

Bakul Patel, the senior policy adviser at the US Food and Drug Administration’s Centre for Devices, said the agency would regulate only those Glass software programs that function as medical devices, the same approach it takes on health applications on hand-held devices.

"The glasses have been on our radar and we’re excited about it," Patel said.

Still, hospitals that are experimenting with Glass say they are doing so very carefully – obtaining patient consent before procedures, using encrypted networks and complying with the federal regulation that protects patient privacy, known as HIPAA.

Medical software developers say they, too, have security and privacy in mind. Pristine, a company based in Austin, Texas, created an app that allows emergency room nurses and doctors beam-in specialists for consultations.

The company plans to sell a customised version of Glass directly to hospitals. It erases Google’s software and configures the glasses with its own HIPAA-compliant programs.

Some hospitals see Glass as a relatively low-cost and versatile innovation, much like smartphones and tablets, which more than half of all healthcare providers use to get access to patient data and other medical information. But hand-held devices are not very useful in the sterile world of surgery.

Glass may be particularly well suited for the surgical suite, where camera-guided instruments, robotics and 3D navigation systems have been commonplace for years, because it is voice-activated and hands-free.

Pierre Theodore, a cardiothoracic surgeon at the University of California, San Francisco, calls wearable computers "a game changer". He uses Glass to float X-rays and CT scans in his field of view at the operating table.

"In surgery, Google Glass is incredibly illuminating,’’ Dr Theodore said. "It helps you pinpoint what you’re looking for, so you don’t have to shift your attention away from the operation to look at a monitor somewhere else."